Ingrown Nails

A Patient’s Guide to Ingrown Nails

By Dr. Michael Zapf

We treat hundreds (probably thousands) of ingrown nails in our office each year.  Ingrown nails come in two varieties: the infected version usually found in teens and young adults and the chronic kind found in more mature patients. What they both have in common is the edge of the nail pushing against the side of the toe.

In the chronic, noninfected version, the skin is not broken. In the acute type, the nail actually penetrates the skin, causing a reaction by the body to get rid of the nail and, sometimes, an actual infection.

The traditional thought is that the nail is too wide for the toe. This might not have mattered in the eons before we, as a race, started wearing shoes. But shoes, and sometimes even socks, squeeze the toe onto the nail, and pain and trouble follow.

Sports and tight shoes contribute to this scenario, and picking and jabbing at it can get it infected. But the real problem, I believe, is that some toes just do not like to be squeezed into a shoe. I call this the “no-fault” ingrown nail.

Treatment of ingrown nails differs depending on the kind you have. Teenagers who develop the infected type need to have the edge of the nail gently removed from the side of the toe. This is traditionally done by first putting the toe to sleep.

Euphemisms aside, I do it with a needle and syringe injection, but I never use these words with a scared patient. Like most podiatrists, I have developed techniques for this injection that make it as painless as possible.

After removing the edge of the nail plate, I dress it with a topical antibiotic and have the patient do this as well for a couple of days. Actual infections require antibiotics.

In our office, every step of this is done with autoclaved sterile instruments while other offices sometimes use instruments just soaked in a disinfectant.

We enjoy the challenge of gently talking a scared young, and sometimes not so young, patient through the procedure.

More mature patients have the other kind of ingrown nail that never looks infected but just chronically hurts with shoe pressure. Some people have lived with this pain for years, not knowing how easy it is to fix it permanently.

After removing the sliver edge of the nail plate, a chemical is placed by the nail root that keeps it from growing back. Recovery requires a few days of wearing an adhesive bandage.

As I write this I realize that we make this surgical procedure look deceptively easy. While some non-podiatrists can do this with efficiency, others are not so skilled.

When you hurt with an ingrown nail, you can nearly never go wrong going to a podiatrist who has done this so many times that his or her gentle confidence can go a long way to making what could be a frightening procedure almost a pleasure.

Every week we hear that our techniques are immensely less troubling than that which they have experienced elsewhere. I guess the pleasure we podiatrists get doing this surgical procedure quickly, efficiently and nearly painlessly goes a long way.

The “ingrowing” part of the nail is not visible but the patient sure feels the pain

After the toe is gently put to sleep, the ingrown piece of nail is removed.

The after the painful sliver of nail is removed, the toenail looks virtually untouched.











You will leave the office with a bandage like this which can be removed in about 10-12 hours and replaced with a band-aid.

Dr. Michael Zapf, Dr. Darren Payne, and Dr. Steve Benson all have years of experience relieving our many patients from their painful ingrown nails.  Call our office more more information or to set up an appointment.

(805) 497-6979 Thousand Oaks

(818) 707-3668 Agoura Hills